Health

10/02/2013

Devota Lyimo stands in front of her property in Dar Es Salaam where spray paint marks the construction location for a water pipeline.

Imagine two men knock on your door one morning and tell you they are pushing your property line back four meters. No consent, no compensation, and no discussion. They return two months later and announce they’re taking another seven meters of land.

That’s the situation for Devota Lyimo and her family living in Salasala, Dar Es Salaam. They’re among hundreds of residents living between the city and Bagamoyo who claim their property rights are being violated for an ongoing pipeline project.

The Dar Es Salaam Urban Water and Sewage Authority kicked off construction on a 56-kilometer Bagamoyo – Dar Es Salaam water pipeline in April, 2013. The goal is to replace the current three-decade old pipeline, in place since 1976, that’s riddled with leaks and aging equipment. The current line provides around 300 million liters of water a day to the city which doesn’t meet the daily demand of 450 million liters. The new line promises the ability to pump 700 million liters of water a day to the city in hopes of shortening the gap of water demand and water deficiencies.

Needless to say the project is one of good intentions and necessity.The problem for many is the pipeline’s path.

Many residents’ homes lay within the projects blue prints and claim they're loosing land or homes all together.

“One day it’s four meters. Then it’s seven. When will it stop? Maybe next it will be our home,” Lyimo worries. And her fear is only a stone throw away. Several of her neighbors have a large red “X” spray-painted on their houses marking their eviction.

Blue and red spray-paint marks notice for many residents living within 15 meters of a future Bagamoyo - Dar Es Salaam water pipeline.

“I’ve invested my whole life to my home. If they take it, I will have zero. I will have nowhere to go. Nothing,” she adds.

Lyimo and her neighbors don’t deny the water pipeline is crucial for the growing population in Dar Es Salaam. In fact they support the initiative to bring the resource within 50 meters of each street in the city, having a lack of water access themselves. But they are criticizing the lack of public consolation, information, and compensation.

However, according to reports on several occasions government and DAWASA officials have stated residents whose property lies 15 meters within the pipeline’s path have been informed and fairly compensated to clear way for construction.

Residents like Lyimo claim they've received no prior knowledge about the project and believe holding a community forum isn’t asking too much before vacating people from their property.

“That’s why we’re doing this now, we don’t understand. It’s already started and people don’t tell us anything” Lyimo shares.

The Kikodoni street chairman promises to bring residents concerns forward in order to find a fair compromise between the need for the pipeline project and residents property rights.

One thing everyone seems to agree upon is water needs to go to Dar Es Salaam. Ensuring citizen’s rights are respected in order to do so is proving to be another battle all together.

09/20/2013

ARUSHA, Tanzania – Welcome to Pippi
House. Karibu sana. Please feel at home. This is Tanzania’s only safe
house for abused and homeless girls, founded in 2011 by Aristides Nshange.

After spending five years establishing a
place for street kids in Arusha, Watoto (kids) Foundation, Nshange felt it was
an unjust policy to only allow boys into the program while leaving girls out in
the cold.

“I decided to start another project in
order to support girls because I found out there was a big need of supporting
girls living on the streets,” he says.

During Nshange’s outreach in the
community, the social worker came into contact with two homeless girls in
Arusha. He consulted his wife and they agreed to house them temporarily until
they could find them a safe place to live. When he couldn’t find anything, he
realized his calling and decided to start Pippi House. A place for these, and
other girls, to call home.

“I’m supporting them with mine and my
wife’s salary,” he says. “We decided we’d try to support these girls as long as
we can by ourselves.”

Pippi Foundation for Girls is now a
certified non-governmental organization (NGO) in Tanzania. Pippi House has 18
girls living together in Arusha. According to Nshange, the girls come from all
over the country and range in age from 13 to 24. The oldest at Pippi House has
two children of her own, a four-year-old girl and a three-month-old boy.

“It’s incredible how safe and happy the
girls are here,” says Cindy Paisio, an Australian counsellor who works with the
girls, trying to heal the physical and emotional scars. “Most of the girls here
were forced into prostitution or beaten and abused by their employers.”

Nshange says many Tanzanian girls begin
working at a young age as domestic servants, cleaning and cooking for wealthier
families. When they are no longer needed for house work, sometimes they are put
out in the street with nowhere else to go, as their kin no longer want them
back, so they end up in vulnerable situations.

The Tanzania director of Girls
Foundation, an American-run organization providing educational opportunities
for adolescent Tanzanian girls, Gwyneth Hesser, believes there’s no other place
like Pippi House.

“Most of the girls Pippi supports were
former housegirls who had run away after being physically or sexually abused
and ended up on the streets,” she says. “Some of them were sent by their
families to work as housegirls at such a young age that they no longer even
remembered the names of their villages, or how to locate their families.”

Family reconciliation is a priority for
Pippi House. But Nshange admits not many families are eager to take their girls
back, so all of them remain at Pippi House for an indefinite amount of time.
When asked about their living conditions, the girls say they feel as if they’re
a part of a family again. A 22-year-old living at Pippi House is even going
back to primary school, taking classes with 10-year-old kids.

“When the girls first came here they
didn’t know how to read or how to write,” Nshange says. “Here we give them a
chance to continue their education.”

An old adage says it takes a village to
raise a child, but at Pippi House, it takes a safe home and family environment
to instill confidence in abused girls. Nshange hopes to see each girl become a
healthy, educated young woman. He’s now looking for funds to keep the doors at
Pippi House open and the project sustainable for the long-term.

08/28/2013

Elizabeth Dasaah, national secretariat for the Domestic Violence and Victims Support Unit (DOVVSU), points to what is supposed to be unit's National Crisis Response Centre, an essential location in Accra to aid victims of domestic abuse. Instead, the building sits unused and unfinished for it's fourth year.

Most people move forward to find solutions to problems. But Elizabeth Dasaah looks back.

Sitting at her desk at the police headquarters in Accra, the national secretariat for the Domestic Violence and Victims Support Unit (DOVVSU), tells my colleague and I why the division, established in 2009 to specifically service Ghana’s abused, is struggling.

“We need more staff,” she says.

In 2012, Ghanaians reported over 15,000 cases of domestic abuse to DOVVSU, which is an increase of 3,000 claims from 2011. Dasaah says the unit responded in 2013 by hiring 50 additional psychologists to their team of about 500 people. Meaning, in theory, each staff member adheres to 30 cases each year.

“But our biggest challenge is office accommodation,” says Dasaah. Adding, it’s one reason they have a limited number of employees. They don’t have room to house any more staff.

She stands from her chair and turns around. Drawing the curtain, she points outside to what is supposed to be DOVVSU’s National Crisis Response Centre. A building the unit started constructing in 2009 to be the main location where victims can report their cases of abuse in Accra.

But as it stands now, both figuratively and physically, the building serves only as a reminder to Dasaah that her unit is not equipped to help Ghana’s victims of domestic violence. Nearly four years later and it sits unfinished and unused, just concrete stacked on concrete right behind Dasaah’s office.

“We need more resources,” she says. “We need external support.”

The centre has 31 rooms by design, which will make up cells to detain abusers, as well as, offices for psychologists, Dasaah adds.

“Usually the challenge for us has been how confidential and private the cases have been handled,” says Wendy Abbey, the executive director at the Human Rights Advocacy Centre (HRAC) in Accra, a group that provides free legal aid to Ghana’s abused, oversees their trials in court, and also, accompanies victims to DOVVSU when filing their claims. “That environment of comfort, that environment of ensuring confidentiality is absent.”

Abbey says there are usually multiple DOVVSU officers in an office at a time, regardless of a victim’s presence.

More funding can also provide DOVVSU officers with vehicles so they can improve response time to the crime scenes, says Dasaah. Which, none have at the moment.

But, while DOVVSU looks for resources to better equip them externally, the unit has internal issues needing attention.

“We need to standardize our approach,” says Dasaah, as she explains her employees have no regimented or systematic protocol when dealing with the abused. The unit’s current tactics, she adds, are “not measurable.”

Which is a worry to people like Abbey at the HRAC.

The group conducted a study on spousal murder last year, another increasing statistic in Ghana. The group found that there is a link between domestic abuse and spousal murder, the more extreme the abuse, the more likely it will end in murder.

“The abuse builds up to the point you would have a murder,” says Abbey. “It’s sort of like the worst form of domestic violence that can ever happen to anybody in a domestic relationship.”

With a surplus of cases, limited staff, and no systematic protocols, it’s these more serious, life-threatening cases of abuse DOVVSU might inadvertently overlook.

“Along the lines they [DOVVSU] drop the cases,” says Adowa Yeboah, one of the 104 lawyers at the HRAC that aids the abused. “They [the abused] always tell us we have been there [DOVVSU] already and nothing is happening.”

The HRAC’s 2012 study says there have been 53 spousal murders in Ghana since 2010. Six were male, the rest female. This year, there have been five spouses murdered since May. According to the study, the country’s average is 24 per annum.

DOVVSU is currently working on developing standardized procedures and training manuals for its staff when dealing with victims, says Dasaah.

Though the 28-year-old works at Tamale's newest family planning clinic, she still had to beg her husband to let her take contraceptives.

"I waited for a day when he was very happy," she says. "It was difficult to convince him ... but he realized that family planning isn't something that would (prevent me from having another child)."

The Marie Stopes International clinic is the only family planning clinic in Ghana's northern region. The U.K.-based NGO has clinics in Accra and Kumasi but a location in Tamale was long overdue, says Kenneth Danuo, the clinic's behaviour change communications coordinator.

"Tamale has a very high fertility rate (and) maternal deaths have also increased in this part of Ghana," he says.

According to the 2008 Ghana Demographics Health Survey, the northen region's fertility rate is 6.8. This means women of child-bearing age have an average of 6.8 children in their lifetime compared to the national average of four children per women of child-bearing age.

Mohammed's approach to contraception is typical for the region, says Danuo.

"The fear of the women is that (their) husbands, for all kinds of reasons, will not want (them) to ... take family planning methods."

The main reason husbands deny their wives birth control are the misconceptions that they will never be able to conceive again, says Danuo.

Data from a recent presentation by the region's Family Planning Services shows married women decline taking contraception for many reasons.

Birth control injections like Depo-Provera are popular, because they prevent pregnancy for up to three months, says Danuo. Women can secretly get the shot and avoid telling their husband they are on birth control.

It's Mohammed's job to teach woman about the different types birth control. She reassures them that their periods won't stop and that they will be able to conceive again.

"Women are coming one-by-one and they don't know what method to choose, but after counselling...they (go) for the injectables," she says.

Like family planning services offered by Ghana Health Services, contraceptives at Marie Stopes are heavily subsidized. Both Marie Stopes and GHS charge 0.50 GHC ($0.25 Cdn) for an injection of Devo-Provera.

Mohammed's son, Muhaison, coos as she bounces him on her lap. Mohammed plans to have more children, but on her own schedule.

There's so much more to Africa than predictable headlines about war, famine and AIDS. From Ghanaian beauty pageants to music in Malawi, Africa Without Maps provides a rare glimpse of life in Africa from Journalists for Human Rights interns on the ground.

05/02/2012

The children of Swaziland's Ekuphileni Care Centre sit sprawled around Siphiwe Khumalo’s knees in a field of dry, yellowing long-grass outside their one-room preschool.

The valley is widely known as a resting place for royalty, and it is where King Mswati III, who has ruled Swaziland’s absolute monarch since 1986, keeps one of his many luxury homes.

Khumalo, who has been a pre-school teacher for nearly 20 years, begins clapping her hands and the children beam up at her attentively; she reads the title of that afternoon's book, “What You Need to Know About HIV and AIDS.”

The stark reality of life for the children living in "Paradise Valley" is far from an enchanting fairytale. Half of the 30 children attending the centre are HIV/AIDS orphans and several are infected with the virus as well.

Swaziland has the highest rate of HIV/AIDS in the world. Twenty-six per cent of population is living with the virus and the average life span is 37.

“It’s good for them to learn about AIDS now, that way they can grow up knowing more than we did,” Khumalo says, “But what they really need right now is a place to sleep.”

Khumalo and other community members are fighting to have an orphanage built to house the estimated 300 orphaned children in the surrounding area.

“In this area, it’s become so bad, almost every house has taken in an orphan, I have three with me now. Their parents die of AIDS and then they are left with nowhere to go,” she says.

The orphanages in the nearby cities are at capacity and individuals living around the pre-school feel it’s important for the kids to remain in their own area, around family and friends, once their parents have died.

Not far from the pre-school is a community centre that was built several years ago by King Mswati III in an attempt to diminish the number of people suffering from HIV/AIDS in the area. He has opened similar centres in many rural communities across the country.

Vilakati Khanyisile, the secretary at the centre, who also plays the role of mother to four orphaned children, says that Mswati's attempt to hinder the epidemic - through the building of the centre - was not enough.

She says that although providing money to construct the building was a good thing, they no longer receive financial support from their government. The centre’s HIV/AIDS awareness programs run based off donations from foreign philanthropists.

The constant flux of foreign donations has caused major problems, such as unsustainable programming, and the donations are not enough to run an orphanage out of the centre.

“It should not be up to foreigners who come here to give us money, our own government, our own king, should be doing better, says Khanyisile.

Khanyisile has contacted government officials to inform them of her community’s needs countless times, but years of being ignored have made her distrustful and frustrated.

There's so much more to Africa than predictable headlines about war, famine and AIDS. From Ghanaian beauty pageants to music in Malawi, Africa Without Maps provides a rare glimpse of life in Africa from Journalists for Human Rights interns on the ground.

04/25/2012

Its 10 p.m. in Malawi’s capital, Lilongwe, and the nighttime vultures that characterize the city at night are out in full force.

Prostitutes prey on drunk men stumbling out of dimly lit bars, while stray dogs are on the hunt for scraps leftover from the hustle and bustle of daylight hours. These desolate streets are no place for a child to grow up, yet many often do.

A 10-year-old boy who didn't want to give his name says he has been sleeping in a gutter outside a popular grocery store for the past three years. He says poverty pushed him into the streets after he lost both his parents to AIDS.

“Most of the time, I beg for money to buy food because I have no one to look after me," he says. “The problem is some men at night will beat us up and take all that we have sourced throughout the day, leaving us with nothing at all”

Chimwemwe, 12, also left home with dreams of finding a better life in the big city, but his experience has been more comparable to a recurring nightmare.

“Some men rape us night," he says “Others beat us and tell us to go away saying that we are thieves in town”

According to UNICEF, there are approximately 8,000 children living on the streets in Malawi’s major urban centers. Most of them are boys, and 80 per cent are AIDS orphans. These youngsters are often labelled by locals as purse-snatching, thugs, but the reality is that many of them have suffered unimaginable physical and sexual abuses.

Dr. Joseph Bandawe, a clinical psychologist at the Malawi College of Medicine, says that homelessness disrupts the sense of safety and security that children need, and as a result, they wander through life lacking self-confidence and being wary of adults.

“The trust and confidence that good things will happen to them is not there," Bandawe says.

“This affects their social interactions – defining the way they’re able to relate to other people, and the boundaries of what is acceptable and what is not.”

Bandawe’s explanation might explain why many of Malawi’s street kids are tempted by a life of crime, but he also suggests that building trust and restoring family ties is imperative when returning troubled kids to school.

Chisomo Childrens Club is a local non-profit working on child poverty issues, and their main mission is to integrate youth back into an ordinary way of life. According to Irene Ngumano, a senior social worker for Chisomo, the biggest challenge in terms of rehabilitation is working with families who were willing to let their children go in the first place.

“Many families that we are working with are poverty stricken families who typically don’t have three meals a day," says Ngumano.

With Malawi’s escalating economic problems, inflation now stands at a staggering 10.9 per cent, causing the prices of essential commodities like bread and sugar to skyrocket. This implies one thing: the number of street children is set to increase unless there is radical policy change.

But Ngumano adds that if families are facing financial difficulties, Chisomo provides monetary assistance which enables them, at the very least, to feed their dependents.

Such was the case with 17-year-old Tikhala Chilembwe who ran away from home in Grade 3. He slept under a bridge for years, until he was discovered by Chisomo social workers who reunited him with his legal guardians and resumed his education.

“My life is okay right now,” says Tikhala, with a smile. “When I’m finished school, I want to become a doctor and I am going to work hard to achieve my goals."

There's so much more to Africa than predictable headlines about war, famine and AIDS. From Ghanaian beauty pageants to music in Malawi, Africa Without Maps provides a rare glimpse of life in Africa from Journalists for Human Rights interns on the ground.

02/09/2012

Nuuna works in one of the vegetable gardens growing in the shadow of Military Hospital No. 37 in Accra, Ghana. The tall 24-year-old is the eldest of five children living in his mother’s house. He works hard to maintain a balance between family obligations and time in the field while also pursuing an education.

Nuuna’s callused hands stand as an example of his hard work, each day he and his siblings earn their pay by plucking crops from the soil, removing the small leaves, severing the stock and binding individual sprigs together to be sold. The bundles are then put into corrugated boxes bound for local and international markets.

“Some stays here, but almost everything we pull up gets sent to the U.K. or Europe,” Nuuna says.

The land where Nuuna grows his crops is irrigated with water drawn from both a well and a stream fed by run-off from city sewers. He says the property is government-owned, but still not on the water supply grid.

“I went to see them (the water and housing commission) about pipes many times," he says. "They would never talk to me, always said to go and come (back later). I think they wanted a bribe or something.”

Without fresh water, farmers like Nuuna are forced to grow crops using the water sources available.

One of those sources is a sewer that contains run-off from Accra's Military Hospital No. 37, built during the Second World War. About a year ago, the pipe carrying raw medical waste from the mortuary, maternity and surgical theatres to the treatment tank was damaged. Unable to fix the line, the hospital began dumping bio-hazardous material into the city’s open-gutters. Now, the sewers are overflowing and downstream the stench of contamination and concern is growing thick.

In the city, clean water is a critical commodity and it doesn’t come cheap. Drinking from faucets is rarely advised and potable sources are most likely found in a bottle or sachet. Open sewers carry liquid and solid waste material of all sort, and when they overflow the result can be devastating.

Last year during the rainy season, Accra was rocked by flooding and the rapid tide of a cholera epidemic. Nearly 6,000 people fell ill with 80 eventually dying from the disease. Cholera can be treated with rehydration fluids but amongst infants, the elderly and the infirm death can occur within hours. The youngest victim of the outbreak was only eight days old when her tiny body succumbed to the bacterial infection.

At this point, no provable connection between hospital waste and outbreak has been established. However, many living near MH-37 have complained of general poor health and the World Health Organization (WHO) advises that epidemics become virulent when water caches are contaminated.

The Globe newspaper and Citi-fm radio station, both based in Accra, developed and broke a medical waste story near the end of January. The news sparked public outrage and in response the AMA (Accra Metropolitan Assembly) formed an emergency fact-finding committee. The investigation found deplorable conditions at the hospital and authored a series of recommendations. The list includes an overhaul of the drainage system and repairs to deteriorating hospital infrastructure, it is also opening the door to charges of criminal negligence.

The AMA’s official report states the target is to prevent future dumping and endangerment of public health. However, the committee failed to acknowledge the residual realities faced by urban farmers in Accra, according to reports.

The hospital was unavailable for comment.

Funding for the jhr bloggers is provided by the Government of Canada’s Youth International Internship Program in Ghana and Malawi, the Canadian International Development Agency in Sierra Leone and the United Kingdom’s Department for International Development in Liberia. Meet the jhr bloggers.

12/19/2011

In Malawi, reports indicate that as many as one in four children have been sexually abused, with orphans and at-risk youth being especially vulnerable. Photo by Travis Lupick.

By Travis Lupick

Dr. Neil Kennedy says he sees an average of 20-25 child sexual abuse cases of a month referred to Queen Elizabeth Central Hospital in Blantyre, Malawi.

I wasn’t sure I heard him correctly.

“Yes, that many,” he confirmed. “I was working a shift last month when I saw three in one day.”

Our conversation was part of a discussion on sexual violence in Malawi. Kennedy, head of pediatrics and child health at the University of Malawi’s College of Medicine, proceeded to dispel any doubts about the scale of the problem.

“Almost one in four children have been forced to have sex against their will,” the document states, “Repeat victimization is common.”

Indicating that little has changed in the six years since that report was published, Malawi’s Daily Times newspaper recently reported that it carried 16 stories covering 22 cases of child sexual abuse for the months of August and September 2011 alone.

Tackling child rape in Malawi is “messy,” Kennedy sighed.

He recounted an example.

A mother brought her seven-year-old daughter into the hospital, the largest health centre in Blantyre, with a case of tuberculosis. TB is a common indication of HIV, and so doctors suggested the girl be tested; the result came back positive, but the girl’s mother swore that she was negative – and an HIV-test of her own confirmed that.

Other possible causes of transmission were subsequently ruled out, and doctors came to suspect that the young girl had been raped. The mother refused to believe it was possible, but agreed to further examination.

Indeed, doctors found every physical indication that the girl had been raped, both repeatedly and over an extended period of time.

There was now a dilemma.

The doctors involved in the case knew the girl’s father, knew that he was HIV-positive, and were certain that he was the man who had assaulted the girl. But doctor-patient confidentiality forbade them from telling anybody about the man’s HIV status, without which, there was significantly less evidence on which to make a case.

Furthermore, the girl refused to say a word about anything that had happened to her. And for the same reasons that doctors couldn’t reveal anything about the father’s health, they were also forbidden from sharing what they had discovered in their examination of the girl.

So what could be done? Ask that question and the matter grows even more complicated.

Speaking alongside Kennedy was Esmie Tembenu, child justice magistrate for the Government of Malawi. She called attention to a massive gap between the number of incidences of sexual assault recorded at hospitals and the significantly-fewer cases filed with police.

“Most victims of sexual abuse in Malawi do not report that they have been abused,” Tembenu said. “The information I have in my office is that as much as 90 per cent of cases of sexual abuse are not being reported to police.”

She counted off an extensive list of contributing factors as to why this is the case. Among others, family members are reluctant to report incest, rapes that occur in extramarital affairs are often concealed, and in cases of child rape, it’s not uncommon for parents to take a bribe from an assailant in exchange for a promise not to press charges.

There are also serious economic considerations a Malawian woman might take into account before reporting her husband for a crime that will put him in jail for years, Tembenu continued.

Let’s say that the household in question falls within the World Bank’s definition for extreme poverty (surviving on less than the equivalent of $1.50 (U.S.) a day) and is comprised of a mother, her husband –the sole breadwinner for the family– the child that’s being raped, her two brothers and a sister, and their two cousins –orphaned from their biological parents because of HIV or AIDS.

If this woman were to have her husband sent to jail, she would find herself left with seven mouths to feed, abysmal prospects for employment, and virtually none of the social security or welfare programs common in the West. With the crime reported, abuse of the child would likely stop, but without her husband’s income, what would happen to the rest of this woman’s family?

Like Kennedy said, dealing with cases of child rape in Malawi is messy.

The “solution” to situations like the hypothetical one outlined above, he said, is usually to send the victimized child to live in another village or to one of the country’s crowded orphanages. But that, of course, goes nowhere near the root of the problem, and leaves a child rapist free to assault other young girls.

This state of affairs may seem bleak. But Kennedy said that he actually sees reasons for optimism.

When he first started seeing child victims of sexual assault at the hospital two years ago, there was no follow-up capacity whatsoever. Now, thanks to a push by UNICEF and the U.K.’s Department for International Development, as many as 40 per cent of sexually-abused children are enrolled in counselling programs and receive regular psychological care.

There are also encouraging signs that Malawi, as a society, is dropping taboos around discussions of sex and sexual assault, Kennedy noted.

“Malawi is going through a huge culture shift about this,” he explained. “It is getting easier to talk about sex... and we know that perpetrators are growing more frightened because of this.”

The seven-year-old girl discussed at the beginning of this article still lives with the man who raped her. Authorities know who he is, but lack the evidence required for a prosecution. However, it was “made clear” to the man that if the sexual abuse didn’t stop, police would catch him. Now authorities can only hope that he has heeded their warning.

12/02/2011

In 2004, Edith Thaulo administered antiretroviral drugs to Dignitas International's very first patient. Seven years later, she is happy to report that the man is still alive.Photo by Travis Lupick.

By Travis Lupick

When Montreal’s Dr. James Orbinski was taken aback when he visited a hospital in Malawi in 2004.

“It was a living hell,” Orbinski writes in An imperfect Offering: Humanitarian Action in the Twenty-First Century. “My knees weakened as I looked around. The hospital was overrun with desperately sick patients. A hundred and fifty people were crammed into a ward that had only 30 beds. Sick people were lying under trees outside. Ninety-per cent of the sick were HIV-positive. It was not a hospital but a morgue.”

This experience inspired Orbinski and a colleague, James Fraser, to leave Doctors Without Borders in 2004 and start Dignitas International, a smaller NGO that would focus on community-based care for people living with HIV and AIDS.

We met Thaulo as part of a tour of Tisungane Clinic ahead of World AIDS Day on Dec. 1.

Dignitas runs Tisungane in partnership with Malawi’s Ministry of Health.

“The clinic started small with just a few staff and a few patients being followed here,” clinic coordinator Edson Mwinjiwa recounted. “Zomba didn’t have any ARV service and it is a big place, with 70,000 people and a high HIV-prevalence rate; about 17 per cent at that time.”

Since then, Mwinjiwa detailed, Dignitas has enrolled approximately 18,000 HIV-positive patients in antiretroviral treatment (of which 10,000 currently remain in the system and make regular visits to Dignitas clinics). And Zomba District’s HIV-prevalence rate has dropped from 17 to 10 – nearly two points below the national.

This wasn’t all accomplished at Tisungane Clinic, Mwinjiwa noted. A big part of Dignitas’ work in Zomba has consisted of capacity-building – training staff to specialize in HIV/AIDS prevention, care, and treatment – throughout the district. In addition to these efforts, Dignitas also opened 22 satellite clinics, which has meant huge gains for ARV accessibility, Mwinjiwa emphasized.

Acknowledging Dignitas’ success, the Ministry of Health recently invited the group to expand into two additional districts –Phalombe and Mulanje – and after that, Malawi’s entire South-East Health Zone.

And so there is much to celebrate. However, Dr. Belete Assefa, Malawi country director for Dignitas International, called attention to recent funding problems that could put much of the progress Malawi has made at risk.

I stopped mid-step, shocked and stared wide-eyed at the gruesome photograph of the young man’s dead body splashed across the front page.

While the act of suicide in Malawi remains taboo, suicide cases are often smeared across the pages of the country’s newspaper. Tabloidization of a suicide victim’s family, personal details and the death are reported on without afterthought. Photographs and suicide letters are also printed.

Families and communities are often shamed after a death because of how the media reports on suicide, explained Kenneth Mtaso, executive Director of Young Voices, a community–based organization that works to protect and promote the rights of youth in Malawi.

Attempting and committing suicide is illegal in Malawi and is treated as a criminal offence rather than a social issue. Section 229 of the penal code states, “any person who attempts to kill himself shall be guilty of misdemeanour.”

This law brings further shame to families of those who try to take their own lives.

“If you are caught trying to kill yourself you go to prison. It can be a jail sentence between four and five years. The police look at the forces that contributed to your suicide and then decide the length,” said Mtaso. “However, this isn’t effective because most people will disregard all punishment to commit suicide.”

There are no definitive statistics or data on how many people commit suicide or attempt suicide and are jailed in Malawi; however, it is believed that the number is growing as the country faces more challenges, such as increasing levels of poverty.

With over 70 per cent of Malawians living on less then a dollar, poverty is an instigator that leads to suicide in Malawi. Poorer rural areas are more at risk for suicides, as there are greater cultural pressures and stigmatization to face there, explains Mtaso.

“In the villages people marry younger making them more susceptible to suicide. Also teen pregnancy is big factor in youth suicide,” said Mtaso. “Because of the stigma surrounding reproductive issues in Malawi, especially in rural areas, middle-aged women who are having trouble conceiving sometime commit suicide because of the pressures to have a baby.”

About 80 per cent of Malawi’s population lives in rural areas.

While there is less pressure on urban youth to marry and have children, alcohol and drugs leads to more youth suicides in Malawi’s major cities.

According to UNICEF, the adult HIV prevalence rate in Malawi in 2009 was 11 per cent, which also contributes to suicide in Malawi.

Young Voices has been offering advice for troubled youth, who are at risk of suicide in Malawi, Zimbabwe and South Africa since 1997.

“We try to emphasize that just because you live in poverty doesn’t mean it’s the end,” said Mtaso. “Young people have a responsibility to protect themselves and value life.”

Africa Without Maps

There's so much more to Africa than predictable headlines about war, famine and AIDS. From Ghanaian beauty pageants to music in Malawi, Africa Without Maps provides a rare glimpse of life in Africa from Journalists for Human Rights interns on the ground.

Funding for the jhr bloggers is provided by the Government of Canada's Youth International Internship Program.

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